DATAd: A new communication and tracking system for treatment-resistant depression.

Abstract

Treatment-resistant depression (TRD) carries a substantial personal and societal burden, yet no universally accepted definition or communication framework exists to guide its clinical management. Current staging models - including the Antidepressant Treatment History Form, Thase and Rush Staging Model, European Staging Model, Massachusetts General Hospital Staging Model, and Maudsley Staging Model - each offer valuable but incomplete approaches to characterizing TRD, and none has achieved broad adoption in routine clinical or research settings. The absence of a standard communication tool results in fragmented treatment histories, inconsistent provider-to-provider handoffs, and missed treatment opportunities for patients. Members of the National Network of Depression Centers (NNDC) Treatment-Resistant Depression Task Group propose the DATAd Tracking System - a simple, scalable framework for documenting and communicating depression treatment history. DATAd organizes prior treatment trials across four clinically meaningful categories: Drugs (primary antidepressants), Augmentation/combination strategies, psychoTherapy, and Advanced treatments (e.g., transcranial magnetic stimulation, electroconvulsive therapy, ketamine/esketamine). For each category, clinicians record both adequate and inadequate trials in the current episode using the notation D#(#) A#(#) T#(#) Ad#(#), with optional lifetime worksheets available to capture historical treatment data. Analogous to the Gravida-Para system in obstetrics and the Tumor-Lymph Nodes-Metastasis (TNM) system in oncology, DATAd provides a common clinical language that highlights treatment gaps, facilitates informed next-step recommendations, and supports both clinical decision-making and research. Ongoing multicenter trials supported by the NNDC will evaluate DATAd's utility, inter-rater reliability, and impact on clinical workflow and patient outcomes.

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